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6 Commonly Misunderstood Medicare Terms Explained

Medicare coverage can be complicated. Between understanding Parts A, B, C and D and breaking down the many aspects of coverage, figuring out what’s best for you or a loved one can be confusing. But you don’t have to go through it alone; at Blue Cross Blue Shield of Michigan we want to help make the whole Medicare process as easy as possible.

To help you better understand your options, we want to de-mystify these commonly-used Medicare terms and phrases:

Initial Enrollment Period: The timeframe when people first become eligible for Medicare coverage. This period lasts for seven months: the three months before you turn 65, the month you turn 65, and the three months after you turn 65.

Special enrollment period: This is when people who qualify can enroll in Medicare outside of their Initial Enrollment Period or the Annual Enrollment Period (October 15 to December 7 each year). You might be eligible for a special enrollment period due to special circumstances like if you move or your plan changes its contract with Medicare.

Medigap: Also known as Medicare Supplement, Medigap plans offer supplemental coverage to enhance Original Medicare coverage. While Original Medicare coverage can cover up to 80% of your health care costs, Medicare Supplement plans add coverage for some of the other 20% to help support deductibles, copays and various other costs. If you think a Medicare Supplement plan may be right for you or a loved one, visit our website.

Pre-existing condition: This refers to an illness or medical condition, like diabetes, diagnosed before you enrolled in a Medicare plan. Most pre-existing conditions do not have an impact on Medicare Advantage coverage, but some, like end-stage renal disease, may alter your coverage and overall costs.

Dual eligible: Being dual eligible means you are eligible for both Original Medicare (Parts A and B), as well as Medicaid (a medical support program for people and families with limited income and means). Being dual eligible is based on a number of factors like your income, resources and enrollment in Medicare Parts A and B. For more information on qualifications, click here.

The Centers for Medicare and Medicaid Services (CMS): This is the federal agency that governs Medicare and Medicaid plans nationwide. Their website is a great source of information for additional questions you may have, as well as the specific rules of Medicare coverage.

It’s also easy to check your Medicare eligibility. Whether you’re growing close to age 65, or face certain medical disabilities, you may be eligible for certain benefits. If you’d like to learn even more about your options for Medicare coverage, visit bcbsmplan.com.

To learn more about the various parts of Medicare and other key terms, you can also check out these posts: